12-1192 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
12-0 0 001192=
Property Address:
78271 DEACON DR W
APN:
770 -210 -036 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JOHN & MARY HELM
VOICE (760) 7-701
FAX (760) 777-7 11
INSPECTIONS (760) 777-7153
Date: 10/08/12
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.). -
Lender's Name:
Lender's Address: K
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above information is co rect. I agree to comply with all
city and county ordinances and state laws relating to building construction, and re Drize resentatives
of thiVu to ter upon a above-mentioned prope r inspection ur s
at y � ' nature (Applicant or Agent
Contractor. /1
Applicant: Architect or Engineer:
ORTEGA MASONRY (�
D
31691
ROSEMARY
THOUSAND PALMS, CA 92276 OCT0 2012
l'
1�
(760)912-1726
LiC. No.: 809220
'1✓v`J
CITY OF LA
FINANCE DEp .
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionao Code, and y License is in full force and effect._
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Clas : C 9 N 809220
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
(%
ra'te:�b a L C actor:
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER-BUILDEXECTION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
K_, certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to throscom rnsation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
00 of the Labor Cod shall forthwith co rovisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by-
Z'"
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001•:
te� licant:
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE1116 GE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS 1$100,0001• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.). -
Lender's Name:
Lender's Address: K
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above information is co rect. I agree to comply with all
city and county ordinances and state laws relating to building construction, and re Drize resentatives
of thiVu to ter upon a above-mentioned prope r inspection ur s
at y � ' nature (Applicant or Agent
Application Number . . . . 12-00001192
Permit . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 3000
Expiration Date . . 4/06/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
120 L.F. 6' GARDEN WALL @ SIDE P/L, CITY
STANDARD. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
--------------------
Due
-------------------------------------
Permit Fee Total 54.00 .00
.00
54.00
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 55.00 .00
.00
55.00
LQPERMIT
CITY OF LA QUANTA
BUILDING.& SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAT EoZs-hz- , l3y--L64-
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Bin.# oty. of La Quinta
Building tat Safety Division I
Permtt # nn
P.O. Box 1504,78-495 Calle Tampico
llh
14.Quinta, CA 92253 - (760) 777-7012
Building Permit
Applicatloaand Tracking Sheet
Project Address: 7 g --
G /a
Owner's Name:. J-0/��3 RNQ
A. P. Number.
Address: - 0 O. L L O.
Legal Description: 1 I oc -ujo,City,
ST, Zip: z� Q �N C 2 2s`-
Contractor.
WIOG-se-1.1
Telephone:
Address: -
Project Description:
City, ST, Zip: 911 w'r42-77C
!ti 64O
y
Telephone: '�tol% 1 Z
_ ��
f`r f:• �!
" '
2O OF
C 4L
,gL O K !a/.4 .
State Lic. #: O' 2 -
City Lia M.
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
Construction Type: ccupancy: Wbrk
State Lic. #:r
•: ,w3%»i4
Project type (circle o,2! . New dd'n Alter Repair Demo
Name of Contact Person:
Sq. FL: !�� # Stories:
# Units.
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd '
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cafes.
Called Contact Person
Plan Check Balance -
Title 24 Calci.
Plans picked up
Construction
_
Ftoodplafnplan_
-Plans resubmitted-------..-------
—Mechanical-- -- ------ --
-
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IDMOUSE:-
3" Review, ready for correctionsfissuc
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees